Trends in treatment and survival of patients with nonresected, nonmetastatic pancreatic cancer: A population-based study
Background: Nonresected, nonmetastatic (NR-M0) pancreatic cancer involves both locally advanced pancreatic cancer and patients who did not undergo resection due to poor health status or patient preference. This study investigates nationwide trends of characteristics, treatment, and survival of patients with NR-M0 pancreatic cancer. Methods: From the Netherlands Cancer Registry, all patients diagnosed with pancreatic cancer between 2006 and 2014 were selected. Chemotherapy and overall survival (OS) of NR-M0 patients were evaluated for 3-year time periods and 2 age groups using chi-square tests for trend and Cox proportional hazard regression analysis. Results: Of 18 234 patients, 33% had NR-M0 pancreatic cancer, which decreased over time (in consecutive 3-year periods: 38%-33%-28%, P < 0.001). Of 5964 NR-M0 patients, 52% was over 75 years of age, 16% received chemotherapy, and median OS was 5.1 months. Chemotherapy use increased over time in younger patients (<75 years: from 23 to 36%, P-trend < 0.001, ≥75 years: 3% to 4%, P-trend = 0.053). In multivariable survival analysis, elderly age, low SES, nonconfirmed cancer, stage II-III disease, and earlier years of diagnosis were independently associated with a worse OS. Age of patients who received chemotherapy increased over time (median 62-66 years) and median OS was 10.4 months without significant differences between time periods (P = 0.177) or age groups (P = 0.207). Conclusions: Overall survival of NR-M0 pancreatic cancer remains poor which is partly related to advanced age of many patients. Despite an increase, chemotherapy is infrequently used. Future research should investigate to what extent the more widespread use of chemotherapy could improve survival in relation to age-related morbidity.
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van der Geest, L.G.M, van Eijck, C.H.J, Groot Koerkamp, B, Lemmens, V.E.P.P, Busch, O.R.C, Vissers, P.A.J, … Besselink, M.G. (2018). Trends in treatment and survival of patients with nonresected, nonmetastatic pancreatic cancer: A population-based study. Cancer Medicine. doi:10.1002/cam4.1750